Externalising Disorders

Question 1

Four disorders

Answer 1

o Conduct disorder

 Adult – antisocial personality disorder

o Attention Deficit Hyperactivity Disorder

o Oppositional Defiant Disorder (lower level CD)

Question 2

Common features of ODD and CD

Answer 2

o Breaking rules

o Argumentative

o Often aggressive

o Note

 More than typical for age

 CD takes precedence over ODD – can’t have both

Question 3

Differences between ODD and CD

Answer 3

o ODD

 More argumentative

 Often touchy and angry

 Often in one setting (e.g. home)

o CD

 More social violations

 More “severe” behaviours (e.g. fire setting, use of weapons)

 Typically across settings

 Often engages peers

Question 4

• Core features of ADHD

Answer 4

o Difficulty with appropriate attentional focus and/or control over activity levels
o Must be more than typical for age
o E.g. unable to sustain attention, follow tasks, organise activities
o E.g. unable to sit still, wait turn, stay quiet

Question 5

• Prevalence of externalising disorders in children

Answer 5

o Difficult diagnoses and very arbitrary cutoffs. Therefore rates vary widely. Around 10% of kids
o Great Smokey Mountains study
 3% ODD
 3% CD
 1% ADHD

Question 6

• Comorbidity

Answer 6

o Very high between each other – lots of overlap
o Depression
 Difficulty with school, peers
o Anxiety – mostly ODD
 CD may be protected
o Substance use – mostly CD
o Learning difficulties, MR

Question 7

• Age and Gender

Answer 7

o Mostly male disorders
 Especially CD – 4x
 ADHD – 3-4x
 Less ODD – 1.5-2x
o Disorders of childhood onset
 ADHD by definition before age 7
 ODD usually early childhood
 CD mid/late childhood – rare after 16

Question 8

• Social/personal correlates

Answer 8

o Academic difficulty/failure
o Truancy
o Peer rejection
o Association with similar peers (esp. CD)
o Family conflict
o Risky behaviours
o Unemployment, marginalisation, prison

Question 9

• Antisocial personality Disorder

Answer 9

o Adult “version” of CD
o Violation of social and personal rights and rules
o Early history of CD
o Continued characteristics such as fighting, breaking law, deceitfulness, lack of remorse

Question 10

• Characteristics of ADP

Answer 10

o Up to 2% of pop
o Largely male
o Tends to decrease with age
o Inconsistent work history
o History of fights, aggression, and risky behaviour
o Common comorbid substance abuse and mood disorders
o Common prison history

Question 11

• Psychopathy vs. APD

Answer 11

o Psychopathy part of earlier systems – dropped in DSM=IV
o Limited affect
o Lack of remorse
o Self-gain focus
o ADP – involves antisocial behaviours e.g. fighting
o Can there be successful psychopaths?

Question 12

• Much more likely to have future problems following ADHD

Answer 12

o 12x ODD
o 10x anxiety depression
o 3x impairment
o 2x juvenile justice

Question 13

• Genetics - ADHD

Answer 13

o Risk for ADHD 2/8x greater among 1st degree relatives
o Twin studies – mean heritability - .76
o Specific candidate genes related to DA, NA and 5HT systems – strongest evidence related to DA receptors and DA transport

Question 14

• Genetic factors in externalising behaviours

Answer 14

o Family concordance – especially in fathers, mothers often depressed
o Twin studies show strong evidence for heritable component – 50%
o Considerable evidence for GxE interactions
o Some hints that psychopathy might be more heritable than antisocial behaviour

Question 15

• Biochemistry of ADHD

Answer 15

o Simple DA theory proposed by Levy (1991)
o Low levels of DA in striatum and frontal cortex
o More recent variations predict more complicated effects
o Complex influence of NorAdrenaline on DA

Question 16

• Evidence for DA involvement in ADHD

Answer 16

o Manipulations of DA levels in animals influence attention, impulsivity & activity
o Stimulants to treat ADHD work largely through DA system
 Reduce activity by increasing DA levels
o Imaging studies show DA abnormalities in specific brain regions
o Genes related to DA implicated in ADHD

Question 17

• CNS arousal and antisocial behaviour

Answer 17

o Two theories – under and over arousal
o Under-arousal suggested to be associated with psychopathic behaviour (callous- unemotional)
o Early theory (Hare) – psychopaths characterised by low arousal and hence fail to learn about punishment and seek greater stimulation
o Evidence mixed – but better when definitions are clear

Question 18

o Temperamental factors

Answer 18

 Several temperaments – risk-taking, impulsivity, low regulation
 Frick – callous-unemotional traits
• Low empathy, low emotion, disregard for others
• Seems to be more heavily genetically mediated
• Likely to characterise a subgroup of externalising children – more severe, more provocatively aggressive, more chronic

Question 19

o Characteristics of callous-unemotional youth – Frick & White, 2008

o Intelligence

Answer 19

 Reduced arousal
 Decreased empathy but especially reduced recognition of fear and distress in others
 Abnormalities in responsiveness to cues of punishment
 Greater thrill-seeking and reduced fearfulness

 More problems with verbal IQ then their peers

Question 20

o Processing biases

Answer 20

 Theory by Dodge and later Crick & Dodge – aggression directly predicted attributions of hostile intent
 Evidence that externalising kids attribute more hostile intent from others directed to self
 In turn, hostile intent predicts aggression
 More aggressive and hostile environments – may be based on experience

Question 21

• Fear recognition and eye gaze in callous-unemotional children

Answer 21

o High CU spent less time looking at eyes, even when told. When compared to low CU.
o When free gaze high CU kids got emotion right significant less than low CU. But this difference disappeared when told to look at eyes

Question 22

• Importance of punishment and reward and CU

Answer 22

o CU kids thought violence would lead to tangible rewards and dominance and valued these as more important and thought punishment was less likely and less important.

Question 23

• Low IQ related to conduct problems

Answer 23

o As IQ goes down both teacher and parent report of conduct problems goes up

Question 24

• Hostile intent in aggressive children and their mothers

Answer 24

o Mothers characterise the vignette behaviour of overt and relational aggression as hostile considerable more than controls. This would have implications for how they interact with their children. This was found to a lesser extent to be true with all children.

Question 25

• Demographic risk factors

Answer 25

o Male
o Low SES
o Impoverished neighbourhood
o Low education

Question 26

• Family risk factors

Answer 26

o Families of externalising children characterised by
 Large family size
 Marital distress
 Family conflict
 Paternal absence
 Maternal depression
 Paternal substance abuse

Question 27

• Parenting and externalising

Answer 27

o Patterson 1980’s – escalation cycle
o Considerable evidence that poor parenting practices are involved in externalising disorders
o Parenting characterised by:
 Poor parent supervision
 Rejection/hostility
 Greater use of harsh punishment
 Inconsistency and poorly defined instruction

Question 28

• Academic and peer relationships

Answer 28

o Externalising children more likely to show:
 Academic failure
 School disengagement and early dropout
 Peer rejection
 Affiliation with deviant peers

Question 29

• Maternal age and family size

Answer 29

o Large family and young mother increases your likelihood of criminal conviction.

Question 30

• Predictors of conduct disorder over 6 years

Answer 30

o ODD 3.3 x the odds
o Low ses 1.7x
o Parent substance abuse 2.9x

Question 31

• Interactions with deviant peers leading to later aggression

Answer 31

o School marginalisation leads to aggressive talk and engagement with deviant peers and later gang involvement and criminal behaviour.